The Department of Defense this month publicly released its newest rationalization for the abusive force-feeding program at Guantánamo Bay. In this latest memo on hunger strike policies, the abusive force-feeding program is referred to as "medical intervention."

Nothing could be further from the truth.

In fact, judging from the heavily redacted memo, it is clear that DoD's aggressive response to ongoing hunger strikes at Guantánamo causes significant pain for the detainees and can be quite dangerous.

Let's start with tube insertion for force- feedings. According to medical experts, long-term feedings should be treated with a singular tube that is not removed from the patient's nostrils except once every four to six weeks. This minimizes patients' experience of the painful insertion process and minimizes the risk of the feeding tube entering the lungs, which could cause asphyxiation.

Compare that standard with the policies at Guantánamo where the feeding tube is inserted up to twice a day for detainees on hunger strike. According to the statement of one detainee, that frequency of tube insertions causes severe pain and can damage the esophagus and stomach.

Relatedly, the practices revealed in the newly published memo leave open the possibility that detainees subject to force-feedings will risk asphyxiation during the force-feeding. During the feeding, a nurse (apparently in addition to one non-medical staff member) is to check that the inserted tube went into the detainee's stomach and not his lungs to ensure that he will not choke during the feeding.

However, the designated process, called "air auscultation," has been discredited in multiple medical journals as outdated and unreliable, and it has been shown to be inaccurate at a rate as high as 93 percent of the time. In this case, medical staff would unknowingly pump water into detainees' lungs.

That sounds like it could be an awful lot like waterboarding.

Now, the feeding itself: Medical equations in the newly released protocols call for 2,300 ml of liquid (a liquid meal replacement such as Ensure plus water) to be pumped down a detainee's esophagus over the course of one feeding. That's just under two thirds of a gallon of liquid. An older version of the newly released text – made public in March 2013 – states that this feeding is to take place over the course of 20 minutes. It is impossible to know due to the extent of redactions in the new document whether that time frame is still used. But if the time window still stands, that means that detainees are force fed almost two thirds of a gallon of liquid in 20 minutes.

For comparison, the American Gastroenterological Association recommends that medical service providers feed patients no more than 260 ml of liquid (about a cup) per 15 minutes. The volume administered at Guantánamo is almost seven times that recommendation.

In addition, the speed of the feeding at Guantánamo may actually cause serious pain and suffering on part of detainees. According to one professor of medicine at the University of Minnesota, the speed of the feeding causes extreme pain and "increases the risk that stomach contents will be regurgitated into the lungs".

Force feeding is a practice universally considered cruel, inhuman, and degrading – and one that violates international medical ethics standards. And it can rise to the level of torture. The "medicalization" of the practice at Guantánamo in no way changes that determination.

Worse, the particular policies that dress in medical terms the DoD's political response to the hunger strike only work to ratchet up the harm suffered by detainees.

Anonymous

It's pretty damn OBVIOUS if you ask me. Nobody's FORCING them to starve themselves. They're doing that by a complete act of sheer conscious will and if you ask me malicious intent. Besides that if we DIDN'T force them to eat, they'd die and you'd be accusing us of THAT. Why is it they always find a way to be passive-aggressive of aggressive-aggressive about everything and then STILL get people to come out like Mark Twain said and "turn on their leaky faucets for horrible people."

He said in his book "Injun Joe had killed 9 people but what of that when all the ladies from town could come down with hankies out and turn on their leaky faucets for someone who was getting the death penalty."

from a family member of someone who was brutally murdered on September 11, when he was armed with the most dangerous of weapons: a pen and a pencil

How the hell much more pain do we have to go through ? An entire lifetime? And for WHAT? What the hell did we ever do to ASK for this shit. We didn't ask for it at all. It came out of a clear blue sky, LITERALLY. If you think the pain ended that morning, you'd be lucky because it means you don't have a clue what it's like to experience it.

March 24, 2014

10:58 AM

Anonymous RN

RN here... perhaps an RN should have written your article??? Here we go...

First of all, most nurses know the feeding tube's not in the lungs/bronchi because if it were, they'd be coughing their brains out. Also, I imagine we can't leave the tube in for weeks since the detainees would remove the tube themselves and it would come out with regular exercise such as walking and sitting and standing. And guess what? Air auscultation is what is done in every hospital: otherwise you'd have to X-Ray after each insertion since X-Ray is the gold standard for checking placement. Now only is that expensive, but at 2 x-rays a day you're looking at a serious increase in their cancer risk. What they should do is aspirate stomach contents and check the pH to ensure correct placement. However, that doesn't solve the problem of having to insert the tube twice a day.

Sorry ACLU, I usually agree with you, but not here. I don't see a better solution to this problem (other than let them starve, but that would be a problem for you too, wouldn't it?)

March 24, 2014

8:30 PM

Vicki B.

Well, I'm a paramedic and even if I've never placed a feeding tube I understand how it works, but the people who do the procedure would HAVE to be qualified professionals so I don't understand how they think they can change all the rules when a medical establishment told them NOT to do it. If they're not supposed to change the tube all the time then why are they doing it anyway? If *I* did crap like that I'd immediately lose my license. This isn't the game Operation when you're treating patients and they're not cadavers. You're SUPPOSED to do procedures exactly as prescribed and in order of how you do it. At least that's how WE do it.

I know from personal experience that it's possible to displace the tube in their lungs, b/c they told me to swallow when they instruct me to do it (I accidentally overdosed on pain medication and they were pumping my stomach; they used the tube through my nose but it wasn't the same as a feeding tube, I'm sure) - except there's no way someone who's being combative and having a hostile attitude about the whole thing is going to swallow when the doctor tells them to in order to AVOID displacing the tube.

The people in question are just willing to die over everything and think they're really wonderful beings beCAUSE they're willing to do all this crap. They act like they think some kind of god is going to greet them on the other side with a great big smile and love in its eyes. Someone in my family died by being burned alive from jet fueled fire. I hardly ever find a place of forgiveness within me for the people who did it to him - and helped finance its creation, like Khalid Sheik Mohammed is accused of doing.

March 28, 2014

2:38 PM

Anonymous

This is sick...

April 2, 2014

2:47 PM

Anonymous

This is sick...

April 2, 2014

2:47 PM

from Richard, V...

People absolutely need to realize they're not playing a game of politics here. You're messing around with real live human beings and your decisions absolutely have to reflect it. Otherwise you belong in a rubber room wearing a jacket with sleeves that tie in the back. I'm referring to the government, who appear to lack a conscience across the entire spectrum, from little to big brother. Example: When winning a war becomes more important than sacrificing soldiers to the fight in order to win it, you've crossed a line and need to step back or stand down - because it's the huMANE thing to do and winning this round be damned. It's certainly not humanitarian to give away a man's life when it hasn't even begun in earnest (referring to soldiers who died under the age of 21 which, at the time, was considered the age of legal adulthood.) Neither that war nor this one should have to sacrifice so damn many people that you leave mothers to weep at graves, siblings to grieve their relatives for a lifetime and dissent to develop in their home country. And for all that we lost the war after the fall of Saigon (now Ho Chi Minh City); so I ask: What the hell did you get that you consider was worth all the pain? Or is it just the fact that nobody in YOUR family gave all, so the pain was never quite transmitted to you. That war to this one: Different names and fighting techniques; same war.

April 2, 2014

6:26 PM

Anonymous

They said they were gonna have to do that to us before, but we never did get forced into the psychiatric hospital and have that done. If they did that we'd not liked that and surely you'd think they could find another way to get someone to eat other than force feeding them that way. They said it hurts them when they use that tube and that they have apparently had to do that before for eating disorder patients like annorexia and bulemia. It's interesting that it's considered bad by the ACLU. It'd have had pork in it and we don't like that. We also wouldn't like people touching us that much.